Care Transitions 2021.pptx

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Transitions to new teams are common during healthcare, esp. perioperative care, and are a potent source of error. How do we reduce this source of problems?

Healthcare

You’re a Patient
❖ Health data with GP
❖ Health data with Surgeon/Specialist
❖ Health data with Hospital
❖ Process repeated in admissions,
holding bay, theatre, ward, discharge

Grocott et al. Perioper Med (Lond). 2017; 6: 9. (Open Access - Creative Commons Attribution 4.0 International
License)
Data Siloes - repeats in
hospital
Largely inaccessible
Repeated data entry
Minimal cross-checking

The Case for Better Use of Healthcare Data
What Do People Want?
Patients
- Information
- Know we care
(Not forms)
Healthcare Workers (HCW)
- Helping patients
- Enjoyable/Meaningful work
(Not forms)

Source: Australian Institute of Company Directors
Has healthcare kept
up?
Not everything has evolved at
the same rate

Healthcare is complex
How do we pursue
this?
Identify things that matter to:
- Patients
- HCW
Typically:
- Safety
- Efficiency
- Great Patient/HCW Experience

www.ichom.org - patient & HCW-centred care - worldwide
Over 80 Disease Sets

Data Sharing
Accessible data
Singular data entry
Cross-checking

Pre-operative (preflight) check
What can we do
Adapt safety/compliance initiatives to
local - our - conditions

Case Example
Team Time Out
Von Willebrand’s Disease
- preop Factor VIII
Spinal Cord Stimulator
- switch off in theatre
No mechanism to ensure this critical information handed
over - even though appropriate actions had been taken

Post-operative (Pre-landing) Check
Team Sign Out
Previous Case Example applies:
- no mechanism to ensure critical data handed
over
- no mechanism to gather team input to potential
problems and improvements
What about preparing for the next case?
- time-saved by alerting relieving staff member

Putting it into practice
Reinventing Healthcare
How do we achieve this
Find a process: something that matters to patients
and/or HCW
Organise a team: critical for innovative ideas
Don’t reinvent the wheel!
Document variations: some necessary, some not
so much
Hypothesise an improvement - to test
13

What this talk was about
❖ Handing over data is important
❖ Humans in healthcare are important
❖ Improve something meaningful
❖ Follow a process

–W. Edward Deming
“94% of failure is a result of the system … Not people.”
Further information, downloads and email newsletter:
www.douglasfahlbusch.com

Apresentação de Carol Haraden durante o SIMPÓSIO EINSTEIN-IHI: Implantação e Disseminação de Programas de Segurança do Paciente aconteceu de 3 a 5 de novembro de 2013, em São Paulo - Brasil. Carol Haraden é PhD, Vice Presidente do Institute for Healthcare Improvement (IHI), é membro do time responsável por desenvolver desenhos inovadores no cuidado ao paciente. Atualmente, ela lidera os trabalhos do IHI na Escócia, Sul da Inglaterra, Dinamarca e Estados Unidos.

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Correctional Health Care Assignment Course Objective for Assignment: · Relate strategic management principles and decision logic to current complex health care management challenges and formulate effective solutions. You applied and were accepted in an internship program of a state-level, Female Correctional Health Care Operation in the Southeastern United States and your primary responsibility is to work on the assigned projects related to the provision of inmate health care. Case Study Associated Materials: ***Correctional Health Care Delivery: Unimpeded Access to Care Section 2 and 4 are recommended for the main reference in working on this assignment. The Health and Health Care of US Prisoners: Results of a Nationwide Survey Public Health Behind Bars Sample Tool Control Policy Inmate Sick Call Procedures-Corrections Case Study Details: For the incarcerated population in the United States, health care is a constitutionally guaranteed right under the provisions of the eight amendments which is the prohibition against cruel and unusual punishment ( see Estelle v. Gamble). This particular prison can hold in excess of 1,728 offenders and routinely houses between 1,600 and 1,700 women on any given day. This institution incarcerates all custody classes to include minimum security, medium security, close custody, death row, and pretrial detainees. The health care operation provides the highest level of care for female offenders in the state. The health care facility is a 101 thousand square foot, 150 bed, three-story building that cost the taxpayers $50 million dollars to construct and is a hybrid of an ambulatory care center, long-term care center, and behavioral care center. The health care facility also houses an assisted living dorm. The patient demographic includes women who have multiple co-morbidities including substance abuse, seriously persistent mental illnesses (SPMI), diabetes, cardiovascular disease, cancer, morbid obesity, HIV / AIDs, hepatitis, etc. On any given day there will also be 30 to 60 offenders who are pregnant, with 98% of those offenders having a history of substance abuse; all pregnant offenders are considered high-risk. The dental health of this patient population is exceptionally horrendous because of excessive drug abuse coupled with a sugary diet and poor oral hygiene practices. It is not uncommon for a 23-year-old to need all of her teeth extracted. There are approximately 300 FTEs to include correctional staff that operate the facility and provide care to the offender population. The healthcare facility is comprised of the following directorates: (a) Medical, (b) Nursing, (c) Behavioral Health, (d) Pharmacy, (e) Dental, (f) Medical Records, (g) Health Service Support, and (h) Operations and Security. Although the health care facility has a vast amount of capability, there limitations: (a) This facility does not have advanced cardiac life support cap ...

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59 minutes ago Luke Powell Initial post - Luke Powell COLLAPSE Top of Form Introduction As nurses, we are guided by evidence-based practice to ensure that the care we deliver is safe and appropriate for our patients. During nursing school, we are encouraged to seek out scientific research to support why we do what we do and are taught to continue to do so even after we leave the classroom. We make decisions based from sources including coursework, our textbooks, and clinical experience (Polit & Beck, 2017). However, I have caught myself asking “what does the research say?” especially when completing cares. In particular, do sequential compression devices (SCD) actually contribute to the prevention of deep venous thrombosis (DVT). Nursing research is conducted to answer questions or solve problems (Polit & Beck, 2017). As I have began to ask my coworkers as to why we use SCDs, the answer is always that this is what we have always done. According to Polit and Beck (2017), this is described as unit culture, and these interventions are based on tradition rather than sound evidence. PICOT Question Many of the patients that I see in the intensive care unit (ICU) can expect to be there for at least three days. Most are too sick to be able to get out of bed and move around the room. This inactivity can potentially put them at risk for developing a DVT. To help prevent this from happening, knee high SCDs are utilized. However, the organization that I work for does not have the evidence they found listed anywhere to support the use of SCDs. In fact, when looking at unit council notes from years ago, the same question was brought up and it was noted that there is no evidence to support their use in the ICU. When conducting research for evidence-based practice (EBP), it is important to create a clinical question that can be answered with research evidence (Polit & Beck, 2017). My PICOT question is “In patients admitted to the ICU, does the utilization of SCDs reduce the risk of DVTs as compared to the use of low dose subcutaneous heparin during a three day admission?” My background questions include: what is a DVT, and what is its pathophysiology? Using PICOT, I can turn this research question into search terms that help to prevent my search from being too broad (Walden Student Center for Success, 2012). Adoption of Evidence-Based Practices Overall, I do believe that my organization is willing to change processes or procedures, if the evidence is there to support such a change. The only problem that I can identify with making those changes is that they must be presented to a committee who reviews our current policies and procedures every two years. Unless there is a strong need to make changes, it could take some time before the specific policy or procedure is up for review. As for my coworkers, we are constantly reevaluating and questioning why we do what we do. It is not that we are trying to find faults within our organization rather that we are try.

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Health Care Change Managent Student’s Name Professor’s Name Date Health care the healthcare facility in which I work is called Upper Hill Care located in California. Some of the characteristic that make our c healthcare facility distinct from others are tied to our culture which is characterized by Friendly communications Respects for all people Embracing diversity Equality and Prioritizing the needs of our clients Readiness for change Our organization is always prepared for changes such as outbreaks of pandemics that can lead to surges in number of patients in various ways such as: Training of employees on working in stressful environment Having extra care equipment's like beds, ventilators and others Preparing for risks through insurance covers ("Preparing for change in your organization: A how-to guide," 2019) Some factors that prepare our firm for changes include. Flexible, secure infrastructure Data mastery Digitally savvy, open talent networks Ecosystem engagement Intelligent workflows Unified customer experience Business model adaptability Again, a digital maturity model is essential for any organization undergoing change – especially those undergoing digital transformation. 3 Current challenge and opportunity for change Some of the current challenges facing our healthcare facility include Lack of adequate trained nurses and doctors Financial deficits Increased employee turnover Misappropriation of the firm resources Increased burden of medical errors Low wages Little time to spend with clients (Shannon Barnet, Molly Gamble, Heather Punke, Emily Rappleye, Ellie Rizzo and Tamara Rosin, n.d.) According to the CareerBuilder survey, the provider shortage is hitting every healthcare organization in the country — especially when it comes to nurses. Forty percent of healthcare workers responded that they felt challenged by work overload at their jobs; the number jumped to 48 percent when the pool was limited to only nurses. The survey also identified a key turnover issue in healthcare workers taking on additional responsibilities above their comfort level. The provider shortage means fewer staff members must divide a significant workload, pushing some employees to the brink of exhaustion and decreasing job satisfaction considerably. 4 orpptunities Some of the orpptunities available for the firm include Diversifying the health care services Opening new branches in other towns Outsourcing employees form hiring agencies Increasing research and development Smart contracts among others (Medal, n.d.) Evidence based idea for change The evidence based idea for change is available for conditions like Asthma Heart failures and Diabetes The changes in the healthcare is believed to have potential of Transforming clients and healthcare workers behavior Minimizing case of asthma, heart failure and diabetes Create a more conducive working environment Increase customers satisfaction ("evidence for evidence-based practice implementati ...

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1. A/Prof. Douglas Fahlbusch, MBBS, FANZCA, GDM, GAICD Reimagining Healthcare Transitions in Care Calvary Adelaide Hospital Grand Round, 6 MAY 2021

2. What this talk is about ❖ Handover of data ❖ Human element of healthcare ❖ Making sense of healthcare complexity ❖ Examples of success ❖ Examples for possible improvement

3. You’re a Patient ❖ Health data with GP ❖ Health data with Surgeon/Specialist ❖ Health data with Hospital ❖ Process repeated in admissions, holding bay, theatre, ward, discharge

4. Grocott et al. Perioper Med (Lond). 2017; 6: 9. (Open Access - Creative Commons Attribution 4.0 International License) Data Siloes - repeats in hospital Largely inaccessible Repeated data entry Minimal cross-checking

5. The Case for Better Use of Healthcare Data What Do People Want? Patients - Information - Know we care (Not forms) Healthcare Workers (HCW) - Helping patients - Enjoyable/Meaningful work (Not forms)

6. Source: Australian Institute of Company Directors Has healthcare kept up? Not everything has evolved at the same rate

7. Healthcare is complex How do we pursue this? Identify things that matter to: - Patients - HCW Typically: - Safety - Efficiency - Great Patient/HCW Experience

8. www.ichom.org - patient & HCW-centred care - worldwide Over 80 Disease Sets

9. Data Sharing Accessible data Singular data entry Cross-checking

10. Pre-operative (preflight) check What can we do Adapt safety/compliance initiatives to local - our - conditions

11. Case Example Team Time Out Von Willebrand’s Disease - preop Factor VIII Spinal Cord Stimulator - switch off in theatre No mechanism to ensure this critical information handed over - even though appropriate actions had been taken

12. Post-operative (Pre-landing) Check Team Sign Out Previous Case Example applies: - no mechanism to ensure critical data handed over - no mechanism to gather team input to potential problems and improvements What about preparing for the next case? - time-saved by alerting relieving staff member

13. Putting it into practice Reinventing Healthcare How do we achieve this Find a process: something that matters to patients and/or HCW Organise a team: critical for innovative ideas Don’t reinvent the wheel! Document variations: some necessary, some not so much Hypothesise an improvement - to test 13

14. What this talk was about ❖ Handing over data is important ❖ Humans in healthcare are important ❖ Improve something meaningful ❖ Follow a process

15. –W. Edward Deming “94% of failure is a result of the system … Not people.” Further information, downloads and email newsletter: www.douglasfahlbusch.com

Care Transitions 2021.pptx

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